Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 014590 | LA |
Y | 207QS0010X | Family Doctor - Sports Medicine | 014590 | KY |
NPI | 1043233968 |
---|---|
Provider Name | Kim Edward Leblanc |
First Address | New Orleans, LA 70112-1221 |
Second Address | New Orleans, LA 70115-6969 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 29/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1309532 | (05) | LA |
B64988 | (02) |